Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment



Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.

Study design:

Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n=12) and major morbidity (n=62) were related to findings at recruitment and on the last assessment preceding delivery.


In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis.


For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Hall DR, Odendaal HJ, Steyn DW, Grové D . Expectant management of early onset, severe pre-eclampsia: maternal outcome. Br J Obstet Gynaecol 2000; 107: 1252–1257.

    Article  CAS  Google Scholar 

  2. Hall DR, Odendaal HJ, Kirsten GF, Smith J, Grové D . Expectant management of early onset, severe pre-eclampsia: perinatal outcome. Br J Obstet Gynaecol 2000; 107: 1258–1264.

    Article  CAS  Google Scholar 

  3. Odendaal HJ, Pattinson RC, Bam R, Grové D, Kotze TJvW . Aggressive or expectant management for patients with severe preeclampsia between 28–34 weeks' gestation: a randomized controlled trial. Obstet Gynecol 1990; 76: 1070–1075.

    CAS  Google Scholar 

  4. Sibai BM, Mercer BM, Schiff E, Friedman SA . Aggressive versus expectant management of severe preeclampsia at 28–32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994; 171: 818–822.

    Article  CAS  Google Scholar 

  5. Witlin AG, Saade GR, Mattar F, Sibai BM . Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation. Am J Obstet Gynecol 2000; 182: 607–611.

    Article  CAS  Google Scholar 

  6. Kutschera J, Tomaselli J, Urlesberger B, Maurer U, Häusler M, Gradnitzer E et al. Absent or reversed end-diastolic blood flow in the umbilical artery and abnormal Doppler cerebroplacental ratio – cognitive, neurological and somatic development at 3–6 years. Early Hum Dev 2002; 69: 47–56.

    Article  CAS  Google Scholar 

  7. Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackeloer BJ, Kok HJ . Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564–570.

    Article  CAS  Google Scholar 

  8. Ferrazzi E, Bozzo M, Rigano S, Bellotti M, Morabito A, Pardi G et al. Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound Obstet Gynecol 2002; 19: 140–146.

    Article  CAS  Google Scholar 

  9. Bashat AA . Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 2004; 23: 111–118.

    Article  Google Scholar 

  10. Alfirevic Z, Neilson JP . Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 1995; 172: 1379–1387.

    Article  CAS  Google Scholar 

  11. Pattinson RC, Kriegler E, Odendaal HJ, Muller LM, Kirsten G . Increased placental resistance and late decelerations associated with severe proteinuric hypertension predicts poor fetal outcome. S Afr Med J 1989; 75: 211–214.

    CAS  PubMed  Google Scholar 

  12. Yang JM, Wang KG . Relationship between acute fetal distress and maternal-placental-fetal circulations in severe preeclampsia. Acta Obstet Gynecol Scand 1995; 74: 419–424.

    Article  CAS  Google Scholar 

  13. Rocca MM, Said MS, Khamis MY, Ghanem IA, Karkour TA . The value of Doppler study of the umbilical artery in predicting perinatal outcome in pre-eclamptic patients. J Obstet Gynaecol 1995; 21: 427–431.

    Article  CAS  Google Scholar 

  14. Chammas MF, Nguyen TM, Li MA, Nuwayhid BS, Castro LC . Expectant management of severe preterm preeclampsia: is intrauterine growth restriction an indication for immediate delivery? Am J Obstet Gynecol 2000; 183: 853–858.

    Article  CAS  Google Scholar 

  15. Shear RM, Rinfret D, Leduc L . Should we offer expectant management in cases of severe preterm preeclampsia with fetal growth restriction? Am J Obstet Gynecol 2005; 192: 1119–1125.

    Article  Google Scholar 

  16. Simanaviciute D, Gudmundsson S . Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies. Ultrasound Obstet Gynecol 2006; 28: 794–801.

    Article  CAS  Google Scholar 

  17. Gramellini D, Piantelli G, Verrotti C, Fieni S, Chiaie LD, Kaihura C . Doppler velocimetry and non stress test in severe fetal growth restriction. Clin Exp Obstet Gynecol 2001; 28: 33–39.

    CAS  PubMed  Google Scholar 

  18. Yoon BH, Lee CM, Kim SW . An abnormal umbilical artery waveform: a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obstet Gynecol 1994; 171: 713–721.

    Article  CAS  Google Scholar 

  19. Sezik M, Tuncay G, Yapar EG . Prediction of adverse neonatal outcomes in preeclampsia by absent or reversed end-diastolic flow velocity in the umbilical artery. Gynecol Obstet Invest 2004; 57: 109–113.

    Article  Google Scholar 

  20. Ebrashy A, Azmy O, Ibrahim M, Waly M . Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: case-control study. Croat Med J 2005; 46: 821–825.

    PubMed  Google Scholar 

  21. Davey DA, MacGillivray I . The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol 1988; 158: 892–898.

    Article  CAS  Google Scholar 

  22. Raio L, Ghezzi F, Cromi A, Nelle M, Durig P, Schneider H . The thick heterogeneous (jellylike) placenta: a strong predictor of adverse pregnancy outcome. Prenat Diagn 2004; 24: 182–188.

    Article  Google Scholar 

  23. Viero S, Chadda V, Alkazaleh F, Simchen MJ, Malik A, Kelly E et al. Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries. Placenta 2004; 25: 735–741.

    Article  CAS  Google Scholar 

  24. Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK . Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. Am J Obstet Gynecol 1985; 151: 333–337.

    Article  CAS  Google Scholar 

  25. Snijders RJ, Nicolaides KH . Fetal biometry at 14–40 weeks gestation. Ultrasound Obstet Gynecol 1994; 4: 34–48.

    Article  CAS  Google Scholar 

  26. Theron GB, Thompson ML . A centile chart for birth weight for an urban population of the Western Cape. S Afr Med J 1995; 85: 1289–1292.

    CAS  PubMed  Google Scholar 

  27. Visser W, van Pampus MG, Treffers PE, Wallenburg HC . Perinatal results of hemodynamic and conservative temporizing treatment in severe pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 1994; 53: 175–181.

    Article  CAS  Google Scholar 

  28. Odendaal HJ, Steyn DW, Norman K, Kirsten GF, Smith J, Theron GB . Improved perinatal mortality rates in 1001 patients with severe pre-eclampsia. S Afr Med J 1995; 85: 1071–1076.

    CAS  PubMed  Google Scholar 

  29. Moldenhauer JS, Stanek J, Warshak C, Khouri J, Sibai B . The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol 2003; 189: 1173–1177.

    Article  Google Scholar 

  30. Bashat AA, Gembruch U, Weiner CP, Harman CR . Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses. Ultrasound Obstet Gynecol 2003; 22: 240–245.

    Article  Google Scholar 

  31. Kaukola T, Rasanen J, Herva R, Patel DD, Hallman M . Suboptimal neurodevelopment in very preterm infants is related to fetal cardiovascular compromise in placental insufficiency. Am J Obstet Gynecol 2005; 193: 414–420.

    Article  Google Scholar 

  32. Schwarze A, Gembruch U, Krapp M, Katalinic A, Germer U, Axt-Fliedner R . Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery – correlation with short-term outcome. Ultrasound Obstet Gynecol 2005; 25: 573–579.

    Article  CAS  Google Scholar 

  33. Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J et al. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999; 180: 750–756.

    Article  CAS  Google Scholar 

  34. Jain M, Farooq T, Shukla RC . Doppler cerebroplacental ratio for the prediction of adverse perinatal outcome. Int J Gynecol Obstet 2004; 86: 384–385.

    Article  CAS  Google Scholar 

  35. Khong TY, De Wolf F, Robertson WB, Brosens I . Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol 1986; 93: 1049–1059.

    Article  CAS  Google Scholar 

  36. Papageorghiou AT, Yu CKH, Bindra R, Pandis G, Nicolaides KH . Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18: 441–449.

    Article  CAS  Google Scholar 

  37. Li H, Gudnason H, Olofsson P, Dubiel M, Gudmundsson S . Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one-third of late third-trimester pre-eclamptic women. Ultrasound Obstet Gynecol 2005; 25: 459–463.

    Article  CAS  Google Scholar 

  38. Ferrazzi E, Bulfamante G, Mezzopane R, Barbera A, Ghidini A, Pardi G . Uterine Doppler velocimetry and placental hypoxic-ischemic lesion in pregnancies with fetal intrauterine growth restriction. Placenta 1999; 20: 389–394.

    Article  CAS  Google Scholar 

Download references


We thank Sr E Carstens for invaluable help with recruitment and data collection, Mrs D Grove for data management and analysis, Mr M Kidd for assistance with statistical analysis. Financial support from the Harry and Doris Crossley Foundation, South Africa, is acknowledged.

Author information

Authors and Affiliations


Corresponding author

Correspondence to L Geerts.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Geerts, L., Odendaal, H. Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment. J Perinatol 27, 335–342 (2007).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • perinatal outcome
  • prediction
  • expectant management
  • fetal weight estimation

This article is cited by


Quick links